There are cries of anguish and accusations of betrayal in Ohio as Governor John Kasich has done an about face and will embrace Obamacare's expansion of Medicaid.
The move highlights the difference between conservative governors who are responsible for the well being of their citizens, and conservative activists who aren't.
Without the Medicaid expansion, the state would have faced dramatically escalating health care costs and the possibility that many rural health care centers would have been forced to close.
Boehner, however, is giving Kasich a pass.
"Gov. Kasich is no fan of Obamacare, and he's proven it repeatedly with his actions," said Boehner spokesman Michael Steel. "Governors are playing the hand they've been dealt by the Obama administration. Gov. Kasich said a strong 'no' to a state-run exchange and to federal takeovers of insurance regulation and Medicaid eligibility. Ohioans applauded him for these actions, and they trust that he's doing his best to minimize the law's harmful effects on our state as Republicans at all levels work for its repeal."
And local health care leaders are praising the move.
Jonathan Archey, a top lobbyist at the Ohio Hospital Association, calls Kasich "a political pragmatist" who recognizes that Medicaid block grants aren't about to happen under Obama and the current Congress - so he's using the offer of extra federal dollars as "an opportunity for Ohio to explore different ways of providing Medicaid services."
But hospital officials and leaders of the Cleveland Clinic have been telling Kasich it's smarter economics to take the feds' Medicaid money than to pass it up. They point to a study, released last month by the Health Policy Institute of Ohio and three other groups, that concluded the state would actually save $1.4 billion from 2014 to 2022 if it expanded Medicaid.
Yes, the state would have higher costs when more people sign up, the study said - $2.5 billion in extra spending over that time. But those costs would be easily outweighed by about $1 billion in savings - as the federal government kicks in a greater share of the payments for newly eligible people - and from nearly $2.9 billion in new revenues, like the taxes that the state collects on managed care premiums.
Following the passage of Obamacare in 2010, I wrote:
In five years, the GOP will have embraced ObamaCare and be running on a platform that boasts how much more efficiently they can manage it.
Pragmatic governance will trump ideology every time. Kasich will be no different than any other Republican governor. Eventually, they will all do the match and come around.